Q-analysis实时弹性成像技术在甲状腺结节良恶性鉴别诊断的应用价值

摘要

Objective To investigate the value of Q-analysis real-time elasticity in differentiating between benign and malignant thyroid nodules. Methods Eighty-six thyroid nodules in 62 patients with pathologic diagnosis were included in this study and were examined using Q-analysis real-time elasticity. The real-time elasticity features were observed and the quantitative index including the whole elasticity rate and the local elasticity rate were compared between benign and malignant nodules. Results There were 51 benign and 35 malignant nodules according to histopathological examination. The Q-analysis curve of real-time elasticity of benign nodules was smoother and with lower peak, compared with that of malignant nodules. The whole elasticity rate of malignant nodules were significantly higher than that of benign nodules (3.59±0.84 vs 2.32±0.56, P=0.000). And the local elasticity rate of malignant nodules were significantly higher than that of benign nodules (3.96±1.32 vs 2.39±0.58, P=0.000). The cutoff point of whole elasticity rate for the differential diagnosis was 3.25 with sensitivity, specificity and diagnostic accuracy as 71.4%, 96.1% and 86.0% respectively. The cutoff point of local elasticity rate for the differential diagnosis was 3.45 with sensitivity, specificity and diagnostic accuracy as 68.6%, 96.1% and 84.9% respectively. The diagnostic efficiency of whole elasticity rate and local elasticity rate had no significant difference (P=0.591).Conclusions Q-analysis real-time elasticity could provide the real-time elasticity features of thyroid nodules. The whole and local elasticity rate as the quantitative index contributed to the differential diagnosis of benign and malignant thyroid nodules.%目的：探讨Q-analysis实时弹性技术对甲状腺结节良恶性鉴别诊断的应用价值。方法选取2012年2月至2014年6月在同济大学附属杨浦医院行甲状腺超声检查，并经甲状腺外科手术获得最终病理诊断甲状腺结节患者62例，共86个甲状腺结节，进行Q-analysis实时定量弹性成像，获得Q-analysis定量曲线及结节的整体弹性比值及局部弹性比值。结果86个病灶中恶性结节35个，良性结节51个。实时弹性图像上显示良性结节的整体及局部弹性比值Q-analysis曲线较平稳，峰值低；恶性结节曲线波动大，峰值高。恶性结节与良性结节的整体弹性比值分别为3.59±0.84、2.32±0.56，两者比较差异有统计学意义（P=0.000）；恶性结节与良性结节的局部弹性比值分别为3.96±1.32、2.39±0.58，两者比较差异有统计学意义（P=0.000）。恶性结节与良性结节的整体弹性比值与局部弹性比值的最佳分界点分别为3.25、3.45，诊断敏感度、特异度及准确性分别为71.4%、96.1%、86.0%与68.6%、96.1%、84.9%。整体及局部弹性比值的诊断效能比较，差异无统计学意义（P=0.591）。结论 Q-analysis实时弹性成像可提供甲状腺结节的动态弹性特征。定量指标整体及局部弹性比值有助于甲状腺结节良恶性的鉴别诊断。